Dr. Jeff Hersh: Jumper’s knee’ a common athlete’s injury

Tuesday

Aug 27, 2013 at 11:17 AM

By Dr. Jeff Hersh

Q: My daughter is a very good soccer player, at least she was until she started having knee pain. We brought her to the orthopedist and he said my daughter’s kneecap tendon was inflamed and she needed to take time off from soccer. Can you tell me more about this?

A: Patellar tendonitis is an inflammation of the patellar (knee cap) tendon, typically caused by overuse. It is sometimes called “jumper’s knee” since it most commonly affects athletes who play sports where there is a lot of jumping, such as basketball, track & field, volleyball or gymnastics, but it can also occur in many other sports, including soccer.

The knee is a very powerful joint. When it is forcibly “straightened out” (extended) it allows athletes to jump high into the air and to kick with amazing strength.

The power of the knee comes from the strong bones [the thigh bone (femur), the shin bone (tibia), the fibula (a smaller bone that sits alongside the tibia) and the patellar], the quadriceps muscles (in the front of the thigh), the tendons (strong bands of tissue that connect muscles to bones) and the ligaments (also strong bands of tissue, but these connect bone to bone). In order for the knee to extend, the quadriceps muscles must contract, pulling on the tendons that reach to the patellar and then onward to the shin (the quadriceps and patellar tendons).

Inflammation of the patellar tendon initially manifests as pain while performing the offending activity that is causing the inflammation. Unfortunately, too many athletes elect to “play through the pain,” which only serves to exacerbate the condition, worsening the inflammation.

If the offending activity continues, more significant tissue damage may occur, such as small or even large (and in extreme cases complete) tears of the tendon. This can cause chronic pain. As the condition progresses it can start to affect the athletes’ performance. This can cause them to perform the activity in an abnormal way, further exacerbating the injury. If the tendonitis gets even more severe it will eventually affect normal everyday activities, such as standing from a sitting position.

During the early stages of patellar tendonitis the recommended treatment is aimed at controlling the symptoms and allowing healing to begin. RICE is an acronym for the initial treatment usually advised, and stands for Rest (stopping participation in the types of activities that cause or exacerbate the condition), Ice (20 minutes every several hours per day for at least several days), Compression (using an elastic wrap; for example, a chopat strap) and Elevation (keeping the leg above the level of the heart for at least several hours per day); it is used to minimize inflammation and to prevent progression of tendon damage.

The next step in treatment is return to limited activities; limited in that the athlete should refrain from any activity that causes pain, as well as refraining from activities that put strain on the knee (such as activities requiring jumping or running). For example, a track & field athlete may start a training regimen centered around swimming.

Usually after several weeks to months the injury has healed enough for the athlete to slowly return to a broader range of activities, with limited jumping, etc. (again limited to things that do not cause pain). The goal here is to strengthen the structures responsible for knee extension, including the quadriceps muscles, as well as improving flexibility. Exercises prescribed by a specialist (often a physical therapist or orthopedist) can be beneficial for this.

Although it is very uncommon, it is possible for the tissue damage to the patellar tendon to become so severe that surgery is required. If this is the case, close consultation with an orthopedist with experience treating this type of injury is important.

As always, an ounce of prevention is worth a pound of cure. A good warm-up prior to athletic participation (including appropriate stretching) and an adequate warm down after finishing an athletic activity, can help prevent patellar tendonitis (or the recurrence of it). Strengthening exercises, as recommended by a physical therapist, athletic trainer and/or orthopedist, are also an important part of good athletic training, and can help minimize injuries.